City & Hackney COVID Rehabilitation Service (City & Hackney CoRe) is a multidisciplinary service to support people with ongoing symptoms following COVID-19 infection (known as Post COVID Syndrome or Long COVID).

Assessment will be carried out by appropriate members of the multi-disciplinary team and may include any combination of GP, respiratory consultant, psychology, physiotherapy, occupational therapy depending on patient needs. 

Where relevant CTPA, ECHO, ECG, bloods, exercise capacity testing and lung function may be performed and, if appropriate, onward referral may be made to Bart’s Health for cardiac MRI and autonomic testing. 

The mainstay of treatment is to help people to develop self-management skills and strategies to support autonomic nervous system regulation to promote recovery, and lessen the impact of living with ongoing symptoms that are affecting daily function.

Treatment may include a combination of any of the following:

• Group programmes – including an introductory webinar; 8 week Moving Forwards programme and standalone workshops
• Individualised treatment with any combination of physiotherapy, psychology, occupational therapy and speech and language therapy
• Care co-ordination for social support including financial, housing and employment alongside therapy
• Recommendation of medication prescription for associated symptoms
• Supported use of apps and websites such as Your COVID Recovery
• Signposting to other community or voluntary sector services (including several activity groups funded specifically for Long COVID - Cook & Eat; Calm & Connect; Walking for Health and Long COVID Peer Support) 
• Onward referral to English National Opera Breathe Programme (ENO Breathe)

Most appointments are at St Leonard’s, with some at Homerton Hospital. Face-to-face and virtual outpatient appointments are offered to meet patient preference and clinical indication. 

The first appointment is likely to be an online virtual webinar for people who have access to a smart phone, tablet or computer. If this is not suitable for your patient (i.e. non-English speaking, no digital access), please note this on the referral and we can instead offer an individual appointment by telephone or face-to-face.

Resources:

• HUHFT Post COVID patient information pack
• North East London (NEL) Long COVID Community of Practice resource page (includes training videos)
• Primary Care Management for Post Covid symptoms (in the Downloads section on this page)
• COVID-19 topic page
• Breathlessness Pathway to support decision-making for identifying urgent assessment and treatment requirements
• NICE Rapid Guideline: Managing the long-term effects of COVID-19
• NEL Long COVID video for GPs (6 mins)

 

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Eligibility criteria

Inclusions

• Suspected or confirmed acute COVID-19, irrespective of whether they were hospitalised or had a positive or negative SARS‑CoV‑2 test (PCR, antigen or antibody).
• Adults over 18 years old
• Must have City & Hackney GP 
• Have had initial thorough primary care assessment in accordance with Clinical reference Guidance to exclude alternative diagnosis
• Have had initial resources provided to support self-management. The Homerton resource pack can be found here.
• CXR within last 4 weeks if ongoing/new breathlessness
• 12 weeks post onset of symptoms (referrals for patients 4 weeks+ may be considered if indicated - please contact the service directly to discuss further)

Exclusions

• Acutely unwell patients including:
  • Unexplained/new sudden onset/worsening breathlessness
  • Severe chest pain or palpitations

(please refer to City & Hackney Urgent post COVID Breathlessness Pathway to identify urgent assessment and treatment requirements)

• Acute COVID <4 weeks
• People who are better managed under a different speciality pathway i.e. Respiratory/Cardiology/Rheumatology where there is a clear medical diagnosis or exacerbation of existing medical condition requiring input from that speciality. Please refer to those specialities as per usual
• Pregnancy – to be reviewed on a case by case basis.
• Referrals for children under 18 years old (there is a pan London Children and Young Person pathway - please refer to Paediatrician in first instance who will be able to refer into Post COVID/Long COVID CYP MDT for assessment and advice)

Considerations

People who would be better supported under a different rehabilitation pathway:

• Physical and functional limitations that would be better supported by another community service like ACRT/IIT/ACN
  • i.e. Best treated in person in their own homes; or exacerbation of existing medical condition leading to deterioration in function (e.g. neuro conditions may be better supported by Neuro ACRT)
• Pre-morbid asthma/COPD may be better served by ACERS in the first instance

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How to refer

The following clinicians can refer to this service: GPs

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Locations

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External Links